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Comment by Retric | Hacker News Reader

While viable and potentially lifesaving, the risks associated with this type of treatment are significant and should not be downplayed.

Edit: This is the line I am objecting to: “it can be used for prevention of infection for people who are being exposed or it could be used for therapy for those who are sick.” This is not something to generally be handing out to people after simple exposure. For one thing the benifit is short term.

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Can you please explain? On the surface this all sounds great, then again, on the surface a lot of things sound great.

Especially looking for clarity around this part:

Are there side-effects to using this?

Plasma is very safe. It is screened for bloodborne pathogens and blood typed so you don't have a transfusion reaction. Blood transfusion is one of the most regulated industries in the United States. It's one of the safest things available.

> Plasma is very safe. It is screened for bloodborne pathogens

For those we know. In some countries with centralized organizations handling transfusions, both HIV and hepatis were spread before they knew to test them -- then even after they learned. People sued for willful poisoning in Europe, as there was documented evidence the persons taking the decision were told about the risks yet decided to ignore them against experts advice. To the best of my knowledge, nobody was convicted, ever.

> Blood transfusion is one of the most regulated industries

Now, given that background, do you think regulations will protect you from unknown pathogens? Or from known ones if someone decides not to bother with the testing?

That was a huge failure on [1] the Canadian Red Cross. They knew the blood was tainted but wanted to use up existing supply. They were buying blood from prisoner populations, didn't bother to do testing that would have detected most of the Hepatitis C cases, and infected more then 2000 Canadians with HIV. This was a giant screw up I have heard many times because back just before it went public the doctors wanted to give my dad a transfusion for a massive cut he sustained at work. He refused saying no way he trusts the blood. It was just a gut feeling. The doctor said he was making a foolish decision. Two weeks later it was all over the paper. So of course my dad took the paper to his next doctors appointment to get his stitches out and asked the doctor what he thought of his decision now. [1]: https://www.cbc.ca/strombo/news/canadas-tainted-blood-scanda...

Or maybe it was Canada, I can't say for sure. I just wouldn't call that a screw up, but deliberate risk taking by managers ignoring experts.

Tell us, what was the doctor reply? That your dad was lucky?

But luck favors the prepared mind - or something like that.

That doesn't make sense at all. It will be limited though and probably only be available to the most ill and front line medical people, there's simply not enough people to provide the plasma especially if it's voluntary.

The JHU team is waiting on FDA approval for a clinical trial...

For example?

You’re injecting blood products from another person so catching some other deadly disease is a real risk. Plasma is tested for AIDS and several other diseases, but prions for example are much harder to detect. Further, when you consider the risk of someone messing up on the supply side that opens up a host of issues.

This paper has a good overview, they say the rate of adverse events is around 1/1700. So if it reduces your risk of death from respiratory failure in the next week by almost any positive amount, it's worth doing.

This is only going to be used in hospitalized patients who are already developing respiratory failure (low blood oxygen levels), not in random people off the street with a cough.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356109/#S1titl...

I agree with you, but here is a direct quote from the article:

“it can be used for prevention of infection for people who are being exposed or it could be used for therapy for those who are sick.” This is not something to generally be handing out to people after simple exposure.

I think your position is reasonable.

In the full perspective article [0], they advocate more for using this treatment to keep medical professionals from succumbing from the disease until a vaccine can be developed.

And they propose what seems like a pretty robust set of safety requirements

[0]: https://www.jci.org/articles/view/138003

Researchers always talk about what could be but not necessarily what should be. Don't worry too much, in practice what you suggest will most likely happen.

That’s why there is comprehensive screening of donated blood which has essentially eliminated pathogen transfer and it’s used en masse everyday.

Screening is not perfect. https://www.redcrossblood.org/faq.html#eligibility-medicaltr...

“ You may not donate if you received a blood transfusion since 1980 in the United Kingdom or France (The United Kingdom consists of the following countries: England, Wales, Scotland, Northern Ireland, Channel Islands, Isle of Man, Gibraltar or Falkland Islands). This requirement is related to concerns about variant CJD, or 'mad cow' disease.”

That is interesting. I have always been told it was stricter than that - basically this:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116429/

The US Food and Drug Administration (FDA) has imposed a ban on blood donations from anyone who has spent more than six months in Britain from 1980 to 1997 because of the possible risk of transmitting the human form of bovine spongiform encephalopathy, known as variant Creutzfeldt-Jakob disease (vCJD)

Nothing about receiving a transfusion there, just having lived in the UK was enough to make you ineligible to donate.

The American Red Cross restriction is weaker. Can anyone clarify?

Looking at the Red Cross page there is a separate travel section which says “ Persons who have spent long periods of time in countries where "mad cow disease" is found are not eligible to donate. This requirement is related to concerns about variant Creutzfeld Jacob Disease (vCJD). See - Eligibility Reference Material“

So i think there is a travel restriction and a transfusion restriction which are independent.

That’s because methylene blue doesn’t kill prions.

https://www.medscape.com/answers/1389957-195354/what-is-the-...

As you say pathogen transfer and other complications like GvHD are rare, but that’s also in normal situations. In a pandemic things change. This example is using plasma from China which is very much outside of normal channels.

Further, in a pandemic when staff are overworked and possibly sick, mistakes are going to increase. Viable in a life threading situation, less so: “for prevention of infection for people who are being exposed.”

Based on the HIV epidemic back in the 1980s, techniques have been developed to inactivate any pathogen in donated plasma. They can use detergents or heat.

Could something slip by? Sure, but it’s a pretty robust system.

What do those techniques do to antibodies?

Presumably nothing.

IV Ig is a very common plasma product. The therapeutic entity is the antibodies and they survive the sterilization process.

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